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Does Donor Terminal, Admission or Best Estimate Glomerular Filtration Rate Predicts Kidney Transplantation Outcomes

G. Irish1, T. Coates2, P. Clayton2

1Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, Australia, 2Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia

Meeting: 2020 American Transplant Congress

Abstract number: C-012

Keywords: Allocation, Graft survival, Kidney transplantation, Renal function

Session Information

Session Name: Poster Session C: Kidney Deceased Donor Allocation

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: When assessing deceased kidney donors, a key factor is donor kidney function. It is unclear whether terminal, admission, or the best of terminal and admission estimated glomerular filtration rate (eGFR) best predicts outcomes. We aimed to examine which eGFR measure most accurately predicts recipient outcomes.

*Methods: Using data from the Australia and New Zealand Organ Donor (ANZOD) and Dialysis and Transplant (ANZDATA) Registries, we included adult recipients of deceased donor kidney-only transplants over 2003-2017. We created multilinear regression models for the outcomes of recipient eGFR at 6 and 12 months. We compared the models using F test and adjusted R squared. We constructed Cox proportional hazards models for the outcomes of graft survival and death censored graft survival.

*Results: 7303 transplant recipients were included in the analysis. There was strong evidence of an association between terminal, admission and best donor eGFR and 6 and 12 month recipient eGFR (figure1). The models performed similarly, although adjusted R squared values were slightly better for terminal eGFR at 6 months and admission eGFR at 12 months. The Cox proportional hazard models showed eGFR was a strong predictor of graft survival, and terminal and best eGFR were better predictors than admission eGFR (figure 2). The C statistics for discrimination were similar across all models (0.65-0.66).

*Conclusions: In deceased kidney donors, admission, terminal and best eGFR are all strongly associated with recipient kidney function. Terminal and best eGFR were slightly better than admission eGFR at predicting graft survival.

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Figure 1: Test statistics and point estimate for multilinear regression and cox proportional hazard
Multilinear regression Cox Proportional Hazard Model
Outcome 6 month eGFR 12 month eGFR 6 and 12 month eGFR Death Censored graft survival
Beta coefficient (SE) F test statistic p value Beta coefficient (SE) F test statistic p value Adjusted R squared Hazard Ratio (95% CI) Wald statistic p value
Terminal eGFR 0.072 (0.009) 9.31 P<0.0001 0.068 (0.009) 7.88 p<0.0001 0.28 0.94 (0.92-0.96) 20.30 p=0.0004
Admission eGFR 0.050 (0.010) 3.85 p=0.0002 0.054 (0.011) 4.59 p<0.0001 0.27 0.95 (0.92-0.98) 9.67 p=0.0464
Best eGFR 0.090 (0.011) 8.99 p<0.0001 0.090 (0.012) 8.25 p<0.0001 0.28 0.94 (0.91-0.97) 16.24 p=0.0027

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To cite this abstract in AMA style:

Irish G, Coates T, Clayton P. Does Donor Terminal, Admission or Best Estimate Glomerular Filtration Rate Predicts Kidney Transplantation Outcomes [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/does-donor-terminal-admission-or-best-estimate-glomerular-filtration-rate-predicts-kidney-transplantation-outcomes/. Accessed May 10, 2025.

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